Key messages from the Close the Gap – Making It Happen Workshop, 24-25 June 2010

The Close the Gap Campaign Steering Committee are

Campaign for Aboriginal and Torres Strait Islander health equality by 2030

Key messages include:

The Workshop reaffirmed the Close the Gap Statement of Intent as a framework for achieving Aboriginal and Torres Strait Islander health equality within a generation (by 2030).

The workshop called for:The Prime Minister to lead and drive the national effort to achieve Aboriginal and Torres Strait Islander •health equality within a generation from within the Australian Government… Aboriginal and Torres Strait Islander people and their representatives to lead in health planning and •implementation processes within the context of partnership arrangements. A planning process for Aboriginal and Torres Strait Islander health equality that is efficient and does not •absorb unnecessary time or resources. The National Health and Hospitals Network to prioritise the effort to achieve Aboriginal and Torres Strait •Islander health equality within a generation.

The complete key messages are set out within this guide.

Since 2006, the Close the Gap Campaign has worked to close the health and life expectancy gap between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians within a generation. Inside this guide, you’ll find information about the Close the Gap Campaign as well as key messages from the Close the Gap – Making It Happen Workshop, 24–25 June 2010, which the campaign convened to explore issues around planning for achieving Aboriginal and Torres Strait Islander health equality.

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Over the last 50-years the health of non-Indigenous Australians has improved significantly due to major advances in medical care and rising prosperity. Aboriginal and Torres Strait Islander Australians, however, have not shared in the same benefits.

The current 10 to 17-year life expectation gap is not a ‘normal’ state of events. It is the result of decades of neglect. The main causes of health inequality are well-known and preventable.

A particular problem is that Aboriginal and Torres Strait Islander peoples don’t have the same opportunities to visit health services as other Australians. As a result, illnesses that could be prevented become chronic problems. The single biggest killer of Aboriginal and Torres Strait Islanders today is preventable – heart disease.

Aboriginal and Torres Strait Islander peoples’ relative lack of access to healthy water, housing and food and, more broadly, social determinants such as lower income and access to education all contribute to poorer health outcomes.

The Close the Gap Campaign comprises Australia’s peak Aboriginal and Torres Strait islander and non- Indigenous health bodies, NGOs and human rights organisations (see back page). They propose a rights based solution to this problem that is embodied in the Close the Gap Statement of Intent reproduced on the opposite page.

In March 2008, then Prime Minister Rudd, the Minister for Health and Ageing, the Minister for Families, Housing, Community Services and Indigenous Affairs, and the federal Opposition Leader signed this document, and since then have almost all the state and territory level governments and opposition parties of Australia. Uniquely, the Statement of Intent embodies a national consensus on how to bring Aboriginal and Torres Strait Islander health inequality to an end within one generation (by 2030).

The Close the Gap campaign for Aboriginal and Torres Strait Islander health equality

The fact that indigenous Australian life expectancy is 10 years less than for other Australians is a cause of great concern ... We want to help provide a level playing field for indigenous Australians ... who face higher risks of diabetes, heart disease, cancer and kidney failure.NRL CEO, David Gallop

Progress has been slow, however, in turning these commitments into action particularly in relation to health planning and partnership. The Close the Gap – Making It Happen Workshop was held on 24–25 June at Old Parliament House in Canberra to provide directions to Australian governments to this end. Representatives from the Aboriginal Community Controlled Health Sector, the mainstream health services as well as Aboriginal and Torres Strait Islander health experts and other stakeholders attended, as did senior representatives from key departments in the Australian Government and representatives from the majority of the state and territory governments.

The key messages from the workshop are set out inside this document.

STATEMENT OF INTENT

Workshop outcomes and key messages

The workshop reaffirmed the Close the Gap Statement of Intent as a framework for achieving Aboriginal and Torres Strait Islander health equality within a generation (by 2030).

Leadership within the Australian Government and COAGThe workshop called for the Prime Minister to lead and drive the national effort to achieve Aboriginal and Torres Strait Islander health equality within a generation from within the Australian Government, and in particular to enable:

The intergovernmental and intersectoral cooperation •vital to a national effort to achieve Aboriginal and Torres Strait Islander health equality within a generation.

The public sector to work in real and effective •partnership with Aboriginal and Torres Strait Islander peoples and their representatives.

A partnership framework agreementThe workshop noted:

Longstanding, strong multilateral partnerships within •the Aboriginal and Torres Strait Islander health sector at the state and territory-level that provide models for moving forward in relation to partnership at the national level.

Partnership opportunities through the structure of the •National Congress of Australia’s First Peoples.That partnership should be considered as an •efficiency measure: helping to maximise the health outcomes for Aboriginal and Torres Strait Islander peoples from the resources available.

The workshop called for a partnership framework agreement between Aboriginal and Torres Strait Islander peoples and their representatives and Australian governments to underpin the national effort to achieve Aboriginal and Torres Strait Islander health equality within a generation.

The development of a plan for Aboriginal and Torres Strait Islander health equality within a generationThe workshop noted that within an overall national effort, several layers and dimensions of health and health-related planning are needed to address all the major social and cultural determinants of health inequality. This includes the Reconciliation process.

The workshop called for:

Aboriginal and Torres Strait Islander people and •their representatives to lead in health planning and implementation processes within the context of partnership arrangements.

Aunty Ruth Bell welcomes the delegates to country, Members’ Dining Room, Museum of Australian Democracy, Old Parliament House, Canberra.

Workshop outcomes and key messages

A planning process for Aboriginal and Torres Strait •Islander health equality that is efficient and does not absorb unnecessary time or resources. A plan that is ‘owned’ by both Aboriginal and Torres •Strait Islander peoples and their representatives and Australian governments. A sense of plan ‘ownership’ on both sides was important to the plan’s implementation. This should be factored into the process of developing a plan.

Content of a plan to achieve Aboriginal and Torres Strait Islander health equality within a generationThe workshop noted:

The content of the • National Aboriginal Health Strategy (1989) and the National Strategic Framework for Aboriginal and Torres Strait Islander Health (2003–2013) that provides a starting point for the development of a plan.The • Close the Gap National Indigenous Health Equality Targets that provide a starting point for the agreement of the targets and sub-targets to be included in a plan.Empowerment will be a vital contributor to Aboriginal •and Torres Strait Islander health equality. Any policy or program under the plan should be assessed as to how it will increase the ability of Aboriginal and Torres Strait Islander individuals, families and communities to take control of their own lives.

The implementation of a plan is, in practice, a more •important step than planning. Aboriginal and Torres Strait Islander leadership and partnership at this stage is vital.

That monitoring, evaluation and review processes •should be included in a plan.

The workshop called for:

The negative impact of racism and the failure to •respect Aboriginal and Strait Islander peoples’ human rights on their health be addressed in a plan (and, more broadly, a national effort) to achieve Aboriginal and Torres Strait Islander health equality within a generation.

The development of a capacity building plan for the •Aboriginal Community Controlled Health Sector as a part of a plan to achieve Aboriginal and Torres Strait Islander health equality within a generation. This includes:

the introduction of a per capita funding model –(based on a robust evaluation of the relative amounts of per capita Indigenous and non-Indigenous government health spending occurring) and,

a streamlining of funding arrangements for these –services.

Mr Ian Thorpe, Patron of the Close the Gap Campaign, welcomes the delegates at the opening session. Ms Catherine Freeman, also Patron of the Campaign, was in attendance.

The Close the Gap Campaign Steering Committee thanks the Australian General Practice Network, the Australian Medical Association and Oxfam Australia for providing financial support for the workshop, and the Hon. Warren Snowdon MP, Minister for Indigenous Health, Rural and Regional Health and Regional Services Delivery, for his support for the workshop during its developmental phase. The Committee also thanks and acknowledges Dr Jeff McMullen AM for his pro bono facilitation of day two of the workshop. This initiative was supported by the Australian Government.

Workshop outcomes and key messages

Mick Gooda, Aboriginal and Torres Strait Islander Social Justice Commissioner and CTG Campaign Steering Committee Co-chair, speaking. From left to right, Mr Justin Mohamed, Chair National Aboriginal Community Controlled Health Organisation; Dr Noel Hayman, Royal Australasian College of Physicians; Dr Tom Calma, CTG Campaign founder, former Aboriginal and Torres Strait Islander Social Justice Commissioner, National Coordinator – Tackling Indigenous Smoking, and CTG Campaign Steering Committee Co-chair; Dr Emil Djakic, Chair, Australian General Practice Network; Gary Highland, Close the Gap Campaign Coordinator, Oxfam Australia; Darren Dick, Director Policy and Programs, Australian Human Rights Commission; Mr Craig Dukes, CEO, Indigenous Allied Health Australia Inc.; Jacqueline Phillips, Executive Director, Australians for Native Title and Reconciliation; Andrew Meehan, Lead – Indigenous Rights Advocacy, Oxfam Australia. At far left, Senator Nigel Scullion.

Opportunities and risks in the current environmentThe workshop noted:

The opportunities to achieve Aboriginal •and Torres Strait Islander health equality within a generation in the current environment: in particular, significant funding allocations through Indigenous-specific national partnership agreements and the high level of political goodwill evident within the political system were encouraging. The space created by the National Health and •Hospital Network reforms provided opportunities to shape the Aboriginal and Torres Strait Islander health space into the future. The Australian Government’s approach to ‘closing the •gap’ is increasing investment in services and housing on the one hand, but – for example by the Northern Territory Emergency Response – undermining the control and empowerment of Aboriginal and Torres Strait Islander peoples on the other.

The workshop called for:

The National Health and Hospitals Network to •prioritise the effort to achieve Aboriginal and Torres Strait Islander health equality within a generation.

This could be progressed through the regional –organisation of Aboriginal and Torres Strait Islander health services on a case by case basis.

A strong national Aboriginal and Torres Strait Islander •health equality authority under Aboriginal and Torres Strait Islander leadership to oversee the development and implementation of a plan for health equality, including the facilitation of partnership arrangements.

The Workshop reaffirmed the Close the Gap Statement of Intent as a framework for achieving Aboriginal and Torres Strait Islander health equality within a generation (by 2030).

Targets and benchmarks should be used in the national plan for Aboriginal and Torres Strait Islander health equality. The Close the Gap Campaign Steering Committee have developed a comprehensive set of National Indigenous Health Equality Targets to guide this target-setting process. These were presented to the Australian Government in July 2008.

Developed by leading experts in Aboriginal and Torres Strait Islander health, the targets are based on the need to address:

the leading causes of Aboriginal and Torres Strait •Islander child mortality – including low birth weight, respiratory and other infections and injuries;

the leading contributing factors to the life expectancy •gap – chronic disease, injuries and respiratory infections; and

mental health and social and emotional well being – •which are crucial to achieving better health.

The targets are intended to support the achievement of Aboriginal and Torres Strait Islander health equality over many areas. Key targets include those in relation to achieving:

significant reductions in the rates of Aboriginal and •Torres Strait Islander death and illness from diseases and chronic conditions;

the delivery of the necessary primary health care •services for health equality to Aboriginal and Torres Strait Islander communities, particularly by Aboriginal Community Controlled Health Services;

big improvements to housing (so that it supports •good health) in Aboriginal and Torres Strait Islander communities;

a dramatic increase in the availability of fresh and •healthy food supplies in Aboriginal and Torres Strait Islander communities; and

significant reductions in the rate of smoking among •Aboriginals and Torres Strait Islanders.

An additional set of targets is being developed by the Close the Gap Campaign Steering Committee to address the broad range of social and cultural factors that have a profound influence on the health of Aboriginal and Torres Strait Islander Australians, such as housing, education, community safety, employment, community development, culture and language and contact with the criminal justice system.

The National Indigenous Health Equality Targets

For details on the National Indigenous Health Equality Targets – including timelines for their achievement and the resources required – go to www.humanrights.gov.au/social_justice/health/targets

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Targets are important because they help maintain a focus on the achievement of Aboriginal and Torres Strait Islander health equality by 2030.

They will also help keep Australian governments accountable for the achievement of this goal.

We stand at a watershed moment in Aboriginal and Torres Strait Islander health. The commitment of Australia’s governments to work in partnership with Aboriginal and Torres Strait Islander peoples and their representatives to plan for health equality by 2030 in the Close the Gap Statement of Intent marks the start of an ambitious, but ultimately achievable, process to bring Aboriginal and Torres Strait Islander health inequality to an end within our lifetimes. To be successful, however, the Close the Gap Campaign will need support from all corners of the Australian community. You can get involved and play a part in consigning Aboriginal and Torres Strait Islander health inequality to the history books.

Further informationSocial Justice Report 2005: • www.humanrights.gov.au/social_justice/health/health_summary.htmlClose the Gap: Solutions to the Indigenous Health •Crisis Facing Australia: www.humanrights.gov.au/social_justice/health/ctg_community.htmlClose the Gap National Indigenous Health Equality •Targets: www.humanrights.gov.au/social_justice/health/targets/index.html2010 Shadow Report on the Australian Government’s •progress towards closing the gap in life expectancy between Indigenous and non-Indigenous Australians: www.oxfam.org.au/resources/filestore/originals/OAus-CloseTheGapShadowReport-0210.pdfClose the Gap Steering Committee Partnership •Position Paper: www.oxfam.org.au/resources/filestore/originals/OAus-CloseTheGapPositionPaper-0610.pdf

Public outreachOver 140,000 Australians have signed the Close the Gap pledge. National Close the Gap Day is held each year to raise awareness of the Campaign. In 2010 over 570 communities held events involving around 40,000 Australians: www.oxfam.org.au/explore/indigenous-australia/close-the-gapThe Close the Gap Campaign has partnered with the NRL who dedicated a Round of Rugby League to Close the Gap. In 2010, the telecast of this Round reached 3.8 million people: www.oxfam.org.au/explore/indigenous-australia/rugby-league-helps-close-the-gap

Contact usAustralian Human Rights CommissionPhone: +61 2 9284 9600, 1300 369 711Fax: +61 2 9284 9611Website: www.humanrights.gov.auEmail: paffairs@humanrights.gov.au

Get involved Who are the Close the Gap Campaign Steering Committee?

Dr Tom Calma, National Coordinator – Tackling •Indigenous Smoking, (campaign founder and Co-chair)Mick Gooda, Aboriginal and Torres Strait •Islander Social Justice Commissioner of the Australian Human Rights Commission (Co-chair)Australian Indigenous Doctors’ Association •Australian Indigenous Psychologists’ Association •Congress of Aboriginal and Torres Strait Islander •NursesIndigenous Allied Health Australia Inc. •Indigenous Dentists’ Association of Australia •National Aboriginal Community Controlled •Health Organisation National Aboriginal and Torres Strait Islander •Health Workers’ Association National Indigenous Drug and Alcohol Committee •Australian General Practice Network •Aboriginal Health and Medical Research Council •Australian Medical Association •Australians for Native Title and Reconciliation •Australian Peak Nursing and Midwifery Forum •Bullana – the Poche Centre for Indigenous Health •The Fred Hollows Foundation •Heart Foundation Australia •Menzies School of Health Research •Oxfam Australia •Palliative Care Australia •Royal Australasian College of Physicians •Royal Australian College of General Practitioners •Professor Ian Ring (Expert Advisor) •